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Which of the following is the principal side effect of Zaltrap?
 
a. Tachycardia
b. Seizure
c. G.I perforation and bleeding
d. Ocular hypertension
e. Diarrhea


Which of the following is the principal side effect of Zaltrap?
 
a. Tachycardia
b. Seizure
c. G.I perforation and bleeding
d. Ocular hypertension
e. Diarrhea
 
Answer:(c). Ziv-aflibercept (Zaltrap) is a recombinant fusion protein consisting of Vascular Endothelial Growth Factor (VEGF)-binding portions from the extracellular domains of human VEGF Receptors 1 and 2 fused to the Fc portion of the human IgG1.
 
Ziv-aflibercept (Zaltrap), in combination with 5-fluorouracil, leucovorin, irinotecan-(FOLFIRI), is indicated for patients with metastatic colorectal cancer (mCRC) that is resistant to or has progressed following an oxaliplatin-containing regimen.
 
Administer Ziv-aflibercept (Zaltrap) 4 mg per kg as an intravenous (IV) infusion over 1 hour every two weeks. Administer Ziv-aflibercept (Zaltrap) prior to any component of the FOLFIRI regimen on the day of treatment.
 
Severe and sometimes fatal hemorrhage, including gastrointestinal (GI) hemorrhage, has been reported in the patients who have received Ziv-aflibercept (Zaltrap) in combination with FOLFIRI. Monitor patients for signs and symptoms of GI bleeding and other severe bleeding. Do not administer Ziv-aflibercept (Zaltrap) to patients with severe hemorrhage.
 
Gastrointestinal Perforation: Gastrointestinal (GI) perforation including fatal GI perforation can occur in patients receiving Ziv-aflibercept (Zaltrap). Discontinue Ziv-aflibercept (Zaltrap) therapy in patients who experience GI perforation.
 
Severe compromised wound healing can occur in patients receiving ZALTRAP/FOLFIRI. Discontinue Ziv-aflibercept (Zaltrap) in patients with compromised wound healing. Suspend Ziv-aflibercept (Zaltrap) for at least 4 weeks prior to elective surgery, and do not resume Ziv-aflibercept (Zaltrap) for at least 4 weeks following major surgery and until the surgical wound is fully healed.
 
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Which of the following is/are non-economic costs associated with Medication Error?

I. loss of trust
II. reduced satisfaction
III. physical and psychological discomfort

a. I only
b. III only
c. I and II only
d. II and III only
e. All


Which of the following is/are non-economic costs associated with Medication Error?

I. loss of trust
II. reduced satisfaction
III. physical and psychological discomfort

a. I only
b. III only
c. I and II only
d. II and III only
e. All

Answer (e): In the two decades since the Institute of Medicine (IOM) released its landmark report providing recommendations for addressing medication errors, the focus on medication safety continues.

A recent meta-analysis of studies spanning from 2000 to 2019 suggest one in 20 patients are exposed to preventable harm in medical care with 25% of incidents being medication-related.

Medication errors impact an estimated 1.5 million people every year.

In 2019, Americans filled 5.96 billion prescriptions (30-day equivalent) which would result in an estimated 93,600,000 errors given a medication dispensing error rate of 1.57%.
The burden of medication errors is high.

Costs of treating drug-related injuries in hospitals are $3.5 billion a year,3 and the morbidity and mortality associated with medication errors is estimated to be $77 billion each year.

Beyond economic costs, errors are costly in terms of patients' loss of trust, reduced satisfaction and physical and psychological discomfort.

They are costly as health professionals lose morale and frustration at providing less than the best care possible.

Continued efforts to address medication error causes are critical to improve medication safety and public health. Pharmacists and the pharmacy team have important roles to play in preventing medication errors.


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Levomilnacipran is indicated for the treatment of:
 
a. Hypertension
b. Depression
c. Epilepsy
d. Renal carcinoma
e. Arrhythmia


Levomilnacipran is indicated for the treatment of:
 
a. Hypertension
b. Depression
c. Epilepsy
d. Renal carcinoma
e. Arrhythmia

Answer:(b). Levomilnacipran (Fetzima), a selective serotonin and norepinephrine reuptake inhibitor (SNRI), is indicated for the treatment of major depressive disorder (MDD).
 
The recommended dose range for Levomilnacipran (Fetzima) is 40 mg to 120 mg once daily, with or without food. Levomilnacipran (Fetzima) should be initiated at 20 mg once daily for 2 days and then increased to 40 mg once daily. Based on efficacy and tolerability, Levomilnacipran (Fetzima) may then be increased in increments of 40 mg at intervals of 2 or more days. The maximum recommended dose is 120 mg once daily.
 
At least 14 days should elapse between discontinuation of an MAOI intended to treat psychiatric disorders and initiation of therapy with Levomilnacipran (Fetzima). Conversely, at least 7 days should be allowed after stopping Levomilnacipran (Fetzima) before starting an MAOI antidepressant.
 
Suicidal thoughts and behaviors in adolescents and young adults, serotonin syndromes, elevated blood pressure, activation of mania/hypomania, seizure and hyponatremia are reported side effects of Levomilnacipran.

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A pharmacist receives a new prescription for Meloxicam (Mobic). The prescription reads:

Take 7.5 mg by mouth every 8 hours with or without meals for the pain associated with rheumatoid arthritis x 30 days. Refill: 5 times.

Which of the following is True?
 
a. Fill it.
b. Call physician to clarify dosage strength.
c. Call physician to clarify indication of drug.
d. Call physician to clarify the frequency of dosing.
e. Change direction to take with meals after verifying with physician.


A pharmacist receives a new prescription for Meloxicam (Mobic). The prescription reads:

Take 7.5 mg by mouth every 8 hours with or without meals for the pain associated with rheumatoid arthritis x 30 days. Refill: 5 times.

Which of the following is True?
 
a. Fill it.
b. Call physician to clarify dosage strength.
c. Call physician to clarify indication of drug.
d. Call physician to clarify the frequency of dosing.
e. Change direction to take with meals after verifying with physician.

Answer: (d). Meloxicam (Mobic), an oxicam derivative, is a member of the enolic acid group of nonsteroidal anti-inflammatory drugs (NSAIDs). Each pastel yellow tablet contains 7.5 mg or 15 mg Meloxicam (Mobic) for oral administration.
 
Meloxicam (Mobic) is indicated for relief of the signs and symptoms of osteoarthritis, rheumatoid arthritis and pauciarticular or polyarticular course Juvenile rheumatoid arthritis in patients 2 years of age and older.
 
For the relief of the signs and symptoms of arthritis the recommended starting and maintenance oral dose of Meloxicam (Mobic) is 7.5 mg once daily since the mean elimination half-life (t½) ranges from 15 hours to 20 hours. Some patients may receive additional benefit by increasing the dose to 15 mg once daily. It may be taken without regard to timing of meals.
 
Nonsteroidal anti-inflammatory drugs (NSAIDs) may cause an increased risk of serious cardiovascular (CV) thrombotic events, myocardial infarction, and stroke, which can be fatal. This risk may increase with duration of use. Patients with cardiovascular disease or risk factors for cardiovascular disease may be at greater risk.
 
NSAIDs cause an increased risk of serious gastrointestinal (GI) adverse reactions including bleeding, ulceration, and perforation of the stomach or intestines, which can be fatal. These events can occur at any time during use and without warning symptoms. Elderly patients are at greater risk for serious gastrointestinal events.


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A pharmacist receives a new prescription for Propecia. The prescription reads:
 
Take 5 mg by mouth once daily with or without meals for male pattern baldness x 30 days.
 
Refill: 5 times
 
Which of the following is True?
 
a. Fill it.
b. Call physician to clarify dosage strength.
c. Call physician to clarify indication of drug.
d. Call physician to clarify a number of refills of drug.
e. Change direction to take with meals after verifying with physician.


A pharmacist receives a new prescription for Propecia. The prescription reads:
 
Take 5 mg by mouth once daily with or without meals for male pattern baldness x 30 days.
 
Refill: 5 times
 
Which of the following is True?
 
a. Fill it.
b. Call physician to clarify dosage strength.
c. Call physician to clarify indication of drug.
d. Call physician to clarify a number of refills of drug.
e. Change direction to take with meals after verifying with physician.

Answer: b
 
The active ingredient found in Propecia and Proscar is Finasteride.
 
Finasteride is a competitive and specific inhibitor of Type II 5-alpha-reductase. The development and enlargement of the prostate gland is dependent on the potent androgen, 5-alpha-dihydrotestosterone (DHT). By reducing the levels of dihydrotestosterone, Finasteride prevents the development and enlargement of the prostate gland.
 
Finasteride (Proscar) is indicated for the treatment of symptomatic benign prostatic hyperplasia (BPH) in men with an enlarged prostate to:
 
1. Improve symptoms
2. Reduce the risk of acute urinary retention
3. Reduce the risk of the need for surgery including transurethral resection of the prostate (TURP) and prostatectomy.
 
The recommended dose of Proscar is 5 mg once daily taken with or without meals.
 
Finasteride (Propecia) is indicated for the treatment of male pattern hair loss (androgenetic alopecia) in MEN ONLY. The recommended dose of Propecia is 1 mg once daily taken with or without meals.
 
Therefore, the pharmacist should clarify the dosage strength with a prescribing physician since the prescription is written for Propecia but prescribed on bases of Proscar dose.
 
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Which of the following is/are 5-alpha-reductase inhibitors?

I. Propecia
II. Avodart
III. Jalyn

a. I only
b. III only
c. I and II only
d. II and III only
e. All


Which of the following is/are 5-alpha-reductase inhibitors?

I. Propecia
II. Avodart
III. Jalyn

a. I only
b. III only
c. I and II only
d. II and III only
e. All

Answer: (e) All. 5-Alpha-reductase inhibitors block the action of 5-alpha-reductase, the enzyme that converts testosterone into dihydrotestosterone, which has greater affinity for androgen receptors. The activity of 5-alpha-reductase inhibitors results in increased levels of testosterone and decreased levels of dihydrotestosterone.

The development and enlargement of the prostate gland is dependent on the potent androgen, 5-alpha-dihydrotestosterone (DHT). By reducing the levels of dihydrotestosterone, 5-Alpha-Reductase inhibitors prevent the development and enlargement of the prostate gland.

5-Alpha-reductase inhibitors are used to treat baldness, prostate hyperplasia and prostate cancer.
Below is the list of 5-Alpha-Reductase inhibitors:

1. Finasteride = Proscar, Propecia
2. Dutasteride = Avodart
3. Dutasteride + Tamsulosin = Jalyn


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**Please note: Under the following states law, Fioricet is classified as a Schedule III controlled drug. **

  1. Georgia
  2. Maryland
  3. New Mexico
  4. Utah
  5. Illinois
  6. Rhode Island
  7. West Virginia



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Which of the following shall be placed on an OTC label for Aleve?

I. take with food or milk if stomach upset occurs.
II. do not exceed 3 tablets in any given 24-hour period.
III. the risk of heart attack or stroke may increase if you use for a prolong period of time.

a. I only
b. III only
c. I and II only
d. II and III only
e. All


Which of the following shall be placed on an OTC label for Aleve?

I. take with food or milk if stomach upset occurs.
II. do not exceed 3 tablets in any given 24-hour period.
III. the risk of heart attack or stroke may increase if you use for a prolong period of time.

a. I only
b. III only
c. I and II only
d. II and III only
e. All

Answer (e): All. Aleve contains Naproxen sodium, a member of the arylacetic acid group of nonsteroidal anti-inflammatory drugs (NSAIDs). Each caplet, tablet, gelcaps or liquid gel capsule contains 220 mg, Naproxen sodium. It temporarily relieves minor aches and pains due to:

a. minor pain of arthritis
b. muscular aches
c. backache
d. menstrual cramps
e. headache
f. toothache
g. the common cold
h. temporarily reduces fever

The recommended dose for adults and children 12 years and older is 1 tablet by mouth every 8 to 12 hours. For the first dose, the patient can take 2 tablets within the first hour. Dose should not be exceeded 2 tablets in any 8- to 12-hour period or 3 tablets in a 24-hour period.

Patients should be instructed to take tablet with food or milk if stomach upset occurs. Patients should be warned that if he/she uses more than directed or for longer than directed, the risk of heart attack or stroke may increase.

G.I. bleeding, ulcer, stomach upset and allergic reactions are commonly reported side effects of Naproxen sodium (Aleve).

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Which of the following classes of drugs shall be strictly avoided with Methylene Blue? [Select ALL THAT APPLY].

a. SSRIs
b. Penicillin Antibiotics
c. Triazole antifungal agents
d. Calcium channel blockers
e. SNRIs


Which of the following classes of drugs shall be strictly avoided with Methylene Blue? [Select ALL THAT APPLY].

a. SSRIs
b. Penicillin Antibiotics
c. Triazole antifungal agents
d. Calcium channel blockers
e. SNRIs

Answer: (a,e). FDA has issued two safety communications regarding adverse drug reactions in patients taking certain psychiatric medications, and also given methylene blue or linezolid (Zyvox). Specifically, FDA has received reports of serious central nervous system reactions in patients taking serotonergic psychiatric medications (SSRIs or SNRIs) who are also given methylene blue, a product commonly used in diagnostic procedures. FDA explains that "although the exact mechanism of this drug interaction is unknown, methylene blue inhibits the action of monoamine oxidase A - an enzyme responsible for breaking down serotonin in the brain.

It is believed that when methylene blue is given to patients taking serotonergic psychiatric medications, high levels of serotonin can build up in the brain, causing toxicity. This is referred to as Serotonin Syndrome.

Signs and symptoms of Serotonin Syndrome include mental changes (confusion, hyperactivity, memory problems), muscle twitching, excessive sweating, shivering or shaking, diarrhea, trouble with coordination, and/or fever.

Similar reports of interactions between certain serotonergic psychiatric medications and the antibacterial drug, Linezolid (Zyvox) have also been reported to FDA.

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Which of the following drugs may cause hyperchloremic acidosis?

a. Nitrofurantoin
b. Amlodipine
c. Zonisamide
d. Capecitabine
e. Adalimumab


Which of the following drugs may cause hyperchloremic acidosis?

a. Nitrofurantoin
b. Amlodipine
c. Zonisamide
d. Capecitabine
e. Adalimumab

Answer: (c). Zonisamide (Zonegran)is an antiseizure drug chemically classified as a sulfonamide and unrelated to other antiseizure agents. It is supplied for oral administration as capsules containing 25 mg or 100 mg Zonisamide.

Zonisamide is indicated as adjunctive therapy in the treatment of partial seizures in adults with epilepsy. It can be taken with or without food. The initial dose of ZONEGRAN should be 100 mg daily. After two weeks, the dose may be increased to 200 mg/day for at least two weeks. It can be increased to 300 mg/day and 400 mg/day, with the dose stable for at least two weeks to achieve steady state at each level. Evidence from controlled trials suggests that Zonegran doses of 100-600 mg/day are effective, but there is no suggestion of increasing response above 400 mg/day.

Zonisamide causes hyperchloremic, non-anion gap, metabolic acidosis (i.e., decreased serum bicarbonate below the normal reference range in the absence of chronic respiratory alkalosis).This metabolic acidosis is caused by renal bicarbonate loss due to the inhibitory effect of zonisamide on carbonic anhydrase.

Generally, Zonisamide-induced metabolic acidosis occurs early in treatment, but it can develop at any time during treatment. Metabolic acidosis generally appears to be dose-dependent and can occur at doses as low as 25 mg daily.

Conditions or therapies that predispose to acidosis (such as renal disease, severe respiratory disorders, status epilepticus, diarrhea, ketogenic diet, or specific drugs) may be additive to the bicarbonate lowering effects of zonisamide.

Some manifestations of acute or chronic metabolic acidosis include hyperventilation, nonspecific symptoms such as fatigue and anorexia, or more severe sequelae including cardiac arrhythmias or stupor. Chronic, untreated, metabolic acidosis may increase the risk for nephrolithiasis or nephrocalcinosis.

Somnolence, anorexia, dizziness, ataxia, agitation/irritability, and difficulty with memory and/or concentration are also reported side effects of Zonisamide.

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